Many Illinois doctor investigations originate in other states

Karisa King, Tribune reporter

Nearly three years ago, the Illinois medical board received a letter urging the agency to investigate a Chicago doctor who tried and failed to intubate a 52-year-old woman after giving her anesthesia that stopped her breathing.

The letter detailed not only the medical error, which preceded the woman's death, but also the doctor's admission in a deposition that he later added dozens of entries to records of the patient's vital signs that were "inaccurate" and "not true," an unusual acknowledgment backed up by court documents. The anesthesiologist and the suburban hospital where he worked agreed to an $8 million settlement.

The Illinois Department of Financial and Professional Regulation, however, has yet to take any apparent action against the doctor, baffling the attorney who sent the letter.

"He failed in the technical job of getting her intubated and then he tried to cover it up," said Bruce Pfaff, who represented the patient's family in the lawsuit. "The (department's) failure to sanction him is unforgivable."

In 2012, the agency responsible for protecting the public from dangerous doctors disciplined fewer than 30 Illinois physicians in cases where the department cited medical errors or failures to properly diagnose a problem, according to a Tribune review of state data.

By contrast, IDFPR took disciplinary action against more than 100 physicians after medical boards in other states found the doctors had engaged in misconduct or provided improper care. The cases involve doctors who hold or have held licenses in Illinois, yet often no longer work here.

Such cases are important to address, patient advocates say, as they prevent incompetent or abusive doctors from simply relocating to another state. But federal figures show that Illinois nearly leads the nation in relying on other states' actions as the basis for disciplining doctors.

Since 2004, about half of all IDFPR actions against physicians were prompted by investigative findings in other states, according to the National Practitioner Data Bank, which compiles information provided by state medical boards. That is a higher rate than all other states except Pennsylvania.

Experts and advocates say that when so-called reciprocal actions far outpace all others, it can signal a lack of effectiveness in more difficult cases. A medical board reacting to another state's action can borrow from evidence collected elsewhere, the turnaround time is faster, and physicians are less likely to fight the discipline.

"It's a lot easier to take a reciprocal action," said David Swankin, an expert on consumer protection boards at the Citizen Advocacy Center in Washington. "You can run up the numbers. They're quicker, cheaper and you can never say they're bad."

Investigating an in-state practitioner for incompetence, substandard care or negligence demands considerably more time, he said.

"They're taking the low-hanging fruit," said Arthur Levin, director of the Center for Medical Consumers in New York. "There is much less that you need to do when another state has done the investigative work for you."

A spokeswoman for IDFPR disputed the figures released by the national data bank, an information clearinghouse overseen by the U.S. Health Resources and Services Administration, saying that inaccurately classified information had inflated the state's rate of reciprocal actions.

The department estimated that from 2004 to 2011 a third of all actions taken were reciprocal, nearly 20 percentage points lower than the data bank's rate for the same period. Even by that standard, however, only five states in the data bank had a rate that was the same or higher.

"We have consistently had problems with the classification system at the NPDB," said spokeswoman Sue Hofer. "Since we don't license by specialty, some of our disciplines are mischaracterized by the national system."

Martin Kramer, a spokesman for HRSA, said the agency is confident that the data bank numbers are correct. Some penalties included in Illinois' total count might not qualify as disciplinary actions at the federal level, HRSA officials said. If Illinois includes those in its analysis, reciprocal actions would account for a smaller share of the total.

Hofer also said the state's high rate of reciprocal actions may partially stem from its large number of medical graduates. Illinois medical schools account for about 6 percent of doctors nationwide, more than all but four other states — California, New York, Pennsylvania and Texas. After obtaining credentials in Illinois, doctors may relocate to other states, creating more potential for reciprocal actions.

"I think that's a huge part of it because we're such a hub of medical training," Hofer said.

Hofer said IDFPR's efforts to impose penalties based on out-of-state violations don't add to the workload of investigators because the department's prosecutors handle reciprocal actions. Despite cuts in staffing, she said, the agency aggressively polices bad doctors and finds ways to take swift action, even in the most complex cases.

"They get the work done," she said. "If it's a case (where) you need to be on it very quickly because the evidence might disappear, they're fully capable of making those judgments and doing triage to get to the most important cases."

According to the National Practitioner Data Bank, Illinois took action against 236 physicians in 2012. Of those, 118 doctors were disciplined after other state medical boards found misconduct or improper care.

Levin said there is no gold standard for a state's rate of reciprocal actions, but the 50 percent rate in Illinois is high. His group questioned the effectiveness of the New York medical board after discovering that about 40 percent of its disciplinary cases originated in other states.

"There aren't many states that reach these levels. I won't say that's good or bad," said Levin. "The question is: What else are you doing?"

In California, which produces more medical school graduates than Illinois, 88 percent of all sanctions against doctors in 2012 were generated in state, according to the data bank.

Cassandra Hockenson, spokeswoman for the Medical Board of California, said investigators carefully weigh the value of repeating discipline by other states. In cases where physicians' licenses have been inactive for several years or the out-of-state sanction was as minor as a reprimand, it's not likely that California will take action.

"If we had to investigate every time what somebody was doing in another state, that would be very costly, time consuming," Hockenson said. "We look very closely at whether a physician is a risk to California consumers."

Instead of expending the time to repeat discipline in every case, California posts all actions by other states to online physician profiles, she said. If a doctor attempts to renew a license in California after being punished in other states, the department will catch it, she said.

In Illinois, IDFPR now relies on an automated process to renew licenses, to ease the growing demands on staff. The computer system will raise a red flag if Illinois has disciplined the doctor, but it is not set up to detect out-of-state actions, Hofer said.

"That's why we manually do sister-state disciplines, so that we can flag the computer to not process a renewal," Hofer said.

Reciprocal actions began ramping up in Illinois around 2004, when the Federation of State Medical Boards began alerting its members about actions taken against licensees in other states.

That year, according to the data bank, IDFPR tallied 74 reciprocal actions, up from nine in 2003. In five of the last eight years, punishment initiated by other states accounted for a majority of IDFPR discipline, peaking at 63 percent in 2010.

Despite the boost in reciprocal actions, the Illinois agency's rate of serious disciplinary actions, including license revocations and suspensions, has dropped since 2005, according to the Federation of State Medical Boards. That year, the department issued 6.43 serious sanctions for every 1,000 licensed physicians. By 2011, that number fell to 4.23 actions.

The department does not classify cases according to the underlying reason for disciplinary action. The Tribune reviewed case summaries, investigative findings and other documents to determine that IDFPR sanctioned fewer than 30 doctors last year in cases where medical errors or failures to properly diagnose a patient are cited.

The paper's analysis also found the agency disciplined about 40 physicians for issues including criminal convictions, fraud, sexual misconduct and personal addiction to drugs or alcohol. About 25 doctors were punished for improperly prescribing drugs. In about a dozen cases the department's data was not detailed enough to determine the basis of the violation.

Cases like the one Pfaff reported against the anesthesiologist can be difficult to prove, costly and time consuming.

Even so, Pfaff said he believed the case provided ample evidence for IDFPR to act. Along with the initial letter to the department, sent in March 2011, Pfaff provided the deposition in which the doctor admitted to altering the patient's records. The department requested more information, and Pfaff said he supplied additional hospital records.

But after October 2011, Pfaff heard nothing. "If they looked at those things and arrived at the conclusion that he shouldn't be punished, I'd be astounded," Pfaff said.

Hofer said state law prohibits the department from commenting on complaints in which no final public action has been taken.

She said IDFPR is efficient and proactive despite tight funding, which is based solely on licensing fees. Until a hard-fought increase last year, the agency's budget had stagnated since 1987, the last time fees rose, she said.

The department's medical unit had just 11 investigators in 2013, down from 19 in 2001. In October, the fee increase allowed the agency to add two more. The number of prosecutors has varied only slightly since 2001 and now totals six attorneys.

In December, each investigator in the agency's medical unit was juggling an average of 135 cases while prosecutors handled an average of 98 cases at a time, records show.

The lack of serious discipline in some in-state cases can have devastating consequences.

In November 2001, the department received a report from the Lake County coroner's office warning about dangerous prescribing habits of Highland Park physician Gerald Kane. A month earlier, one of Kane's patients, Anthony Sorrentino, had died of a drug overdose. Sorrentino, 26, was receiving a powerful mix of pain medications from Kane that included Soma, Norco, Darvocet and Vicodin, records show.

In the three years he'd been seeing the doctor, Sorrentino's narcotics addiction had become painfully obvious to his mother, sister and aunt, who each said they lobbied Kane's office to stop the supply of pills.

Sorrentino lost a string of low-wage jobs and caused multiple fender benders because he couldn't stay awake, said his sister, Christina. Three pharmacies in the area had grown so suspicious they stopped filling his prescriptions, she said.

Even while Sorrentino was in a drug rehab program, Kane continued to dole out the prescriptions, according to IDFPR records. Filled two days before he died, his last prescription from Kane arrived by fax.

"Out of fear and concern for other mothers and all people who might frequent this doctor ... I suggest at least investigating this doctor if not removing his license," Sorrentino's mother, Diana, wrote in a complaint to IDFPR, a week after the coroner's office sent its own report.

Family members said they received no response. Three years later, administrative prosecutors in IDFPR filed a complaint accusing Kane of gross negligence and asking the department to revoke or suspend his license, but no apparent discipline resulted from the case.

The agency did not suspend his license until June 2007, amid an investigation by the U.S. Drug Enforcement Administration, IDFPR and local law enforcement.

Lake County prosecutors later accused Kane of overprescribing painkillers to three other patients who died of overdoses in 2006 and 2007.

Kane pleaded guilty in 2009 in Lake County Circuit Court to reckless conduct and was placed on probation for 30 months. He declined to comment, as did Hofer.

"They had to wait until three other people died before they did anything?" Diana Sorrentino said. "It's hard to understand."